Paying Kidney Donors Is Cost-Effective, Researchers Say

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The idea of using financial incentives in organ donation, such as
paying kidney donors, has been subject to heated debate. Now, a
new study shows that using this strategy to address the shortage
of kidneys would be less costly and more effective than the
current organ donation system, researchers say.

In the study, researchers found that assuming a payment of
$10,000 and an increase of kidneys available for transplantation
by 5 percent, a strategy of paying living donors would save the
health system $340 over the lifetime of each patient, compared
with the current organ donation system. The study was published
today (Oct. 24) in the Clinical Journal of the American
Society of Nephrology.

The savings come from lower costs and improved health outcomes
over the recipient's life. "Transplant has a higher upfront cost,
but the yearly maintenance cost is lower than dialysis," said
study author Lianne Barnieh, a researcher at the University of
Calgary. [ The
9 Most Interesting Transplants ]

A 5-percent increase in donations would mean an additional 5
kidneys transplanted yearly for every 100 transplants currently
performed, and would improve patients' net health by gaining 0.11
quality-adjusted life years on average over a patient's lifetime.

Dialysis or kidney transplantation are the only treatment options
for people whose kidneys
have failed and are no longer able to remove wastes from
the blood. Currently, about 98,000 people are on the
national waiting list for kidney transplantation, whereas about
17,000 kidney transplants, mostly coming from deceased donors,
were performed in 2012, according to the U.S. Department of
Health and Human Services.

But before exploring the legal and ethical challenges around paid
donations, researchers should first determine whether such a
strategy is cost-effective, Barnieh said. "If it's going to cost
the health system too much money, and not improve outcomes for
the patients, there is no point going forward with that."

The
ethical concerns and practical challenges of such a
strategy include opposition from religious groups who oppose the
sale of organs.

"A large number of people would not support this strategy and may
withdraw from the system," said Arthur Caplan, a bioethicist at
New York University School of Medicine's Division of Medical
Ethics. Although many would like to see an increase in organ
donations, with this strategy, "you are playing with fire,"
Caplan told LiveScience. The argument could become politically
charged, like the pro-life and pro-choice divide, he said. "You
don't want to make organ donation into an abortion debate."

Another negative consequence of setting up a government-regulated
organ market is losing the credibility to criticize exploitive
human organ trafficking that happens in some developing
countries, Caplan said.

In the payment strategy, any money paid to donors is not
technically used to buy the kidney, but is rather thought of as
compensation for the pain and suffering of undergoing major
surgery.

"Part of the reason we chose $10,000 was that we didn't want it
to be so much money that it would change someone's life
completely," Barnieh said. "We didn't want it to be a persuasive
tactic, but a compensation for the pain and suffering. And to tip
the balance of those who are maybe considering donation."

Caplan said that systems that operate under "presumed consent,"
in which people are donors by default but can opt out, is likely
the best strategy to expand the pool of organ donors. This method
has shown impressive results in countries, like Spain, that have
adopted it.

"We presume people do not want to be donor. We should turn that
around," he said. "People who don’t want to do it can opt out,
and carry a card."